Having a perineal cyst or lump can be caused by anything from an injury to a sexually transmitted illness (STI). It’s often not serious, but if you experience pain or swelling, your doctor can rule out more concerning causes.

The perineum is a small patch of skin, nerves, and blood vessels between your genitals and anus. It’s sensitive to the touch, but it’s not much to write home about otherwise.

The perineum typically doesn’t seem that important because it’s small, typically unseen, and doesn’t really seem to serve much purpose.

But at some point, you may notice a lump on or near your perineum. Sometimes it’s be expected, such as when you’re pregnant, and the perineum becomes swollen or painful near the end of the pregnancy.

In other cases, you may feel perineum pain or notice abnormal bleeding or discharge from the perineum. This can disrupt otherwise simple daily tasks like sitting or using the bathroom.

There are a few reasons you can get a perineum lump. Some perineum lumps are harmless, but others, like hemorrhoids, may cause discomfort or pain and require treatment.

Some causes of perineum lumps are common to all sexes. But others are more common in people with vulvas than in people with penises.

We’ll start with common causes in all sexes, and then we’ll get down to the specific causes of perineum lumps in people with vulvas and people with penises.

Common causes in all sexes

Here are some of the possible causes of perineum lumps regardless of sex:

Injuries

Impacts to the groin area during physical activity or from falling on your rear can bruise, tear, or rip your perineum, causing a lump there.

A lump can also result from chronic injuries to the nerves, blood vessels, and skin from pressure caused by sitting for long periods of time.

Pelvic floor dysfunction

Pelvic floor dysfunction happens when the muscles and ligaments around the bottom of your hips are injured, strained, or weakened.

This causes the muscles to involuntary tighten or contract when they’re supposed to be relaxed. A perineum lump may appear where muscles are tight.

Hemorrhoids

Hemorrhoids happen when blood vessels near your anus or rectum get swollen. You may notice them as tender or painful lumps close to your perineum.

Sexually transmitted infections (STIs)

Many common STIs, like herpes and pubic lice, can cause red bumps around your genital and anal area, including on your perineum.

Cysts

These are fluid-filled sacs that can develop in the anus, though they don’t typically cause any symptoms. However, they can fill with fluid over time and become large enough to make it difficult to sit.

Abscesses

An abscess happens when an opening in your anus gets filled with infected pus. This can result in swelling near your perineum.

Hematoma

A perineal hematoma happens when blood pools in the blood vessels under the skin of your perineum, pushing up the skin and causing a lump.

Cancer

A cancerous tumor can grow on the skin of the perineum or in the tissues underneath, resulting in a lump. It may get bigger and more painful or tender over time.

Both benign and cancerous tumors are more common in your 30s and 40s.

In people with vulvas

Here are some possible causes of perineum lumps that are more common in people with vulvas:

  • Urinary tract infections (UTIs). UTIs happen when your urethra, bladder, or kidneys get infected. They’re more common in people with vulvas because the urinary tract is much shorter, and infectious bacteria can get in more easily. Swelling from a UTI can make your perineum swollen or tender.
  • Interstitial cystitis. Interstitial cystitis happens when the muscles around your bladder get inflamed, sometimes resulting in swelling near your perineum. This happens to people of all sexes, but it’s most common in people with vulvas.
  • Vulvodynia. Vulvodynia refers to pain around your vulva that can last for long periods of time, sometimes resulting in swelling around your perineum.
  • Pyramidal protrusion. This is a skin tag that sticks out from the tissues of the perineum. It doesn’t typically cause any pain or discomfort, and it’s most commonly diagnosed in young children.
  • Swelling during pregnancy. Swelling around the perineum is common during the third trimester of pregnancy.
  • Complications of an episiotomy. During some births, doctors make an incision from the vagina through the perineum called an episiotomy to make it easier for a child to come out. When the perineum is repaired after birth, you may experience bumps, swelling, and itchiness around the perineum as the tissues heal.

In people with penises

The main cause of a perineum lump in people with penises is prostatitis.

Prostatitis can happen when the prostate gland becomes swollen, which can push against the perineum and cause a lump to appear.

Here are some other symptoms you may notice along with a perineum lump:

  • redness around the swollen area
  • bruising
  • itching
  • unusual discharge from the lump, your genitals, or your anus
  • bleeding, especially after an injury or from a hemorrhoid
  • an open wound
  • unusual new growths or discoloration around the perineum
  • pain when you pee or poop
  • having trouble peeing

See your doctor if you experience any intense pain or discomfort along with these symptoms.

Your doctor will likely begin a diagnosis by requesting your medical history. They will then do a physical exam of your entire body, including your perineum.

Your doctor may palpate (lightly touch) your perineum and the surrounding tissues to see if you experience more pain and discomfort when pressure is applied.

They may also order a urine or blood test to check for any abnormalities that might be related to the perineum lump. This is especially important if they’re concerned that you may have an infection or cancerous tumor.

Your doctor may also want to order imaging tests like X-rays or a functional magnetic resonance imaging (fMRI) test to look more closely at any abnormalities in your perineum area.

Once your doctor has confirmed their diagnosis, they’ll walk you through the next steps for treating the cause of your perineum lump.

Here are some treatments you can try to help reduce the discomfort, pain, or swelling that might accompany a perineum lump:

  • Use a donut or hemorrhoid pillow to reduce the pressure on your perineum from your own weight while you sit, especially if you’re sitting for a long period of time or on a hard surface.
  • Use a cold compress or ice pack to relieve pain and swelling in the perineum area.
  • Wear looser pants or clothing that reduce pressure on your perineum and the surrounding area. Try shorts instead of jeans, a dress instead of pants, or boxers instead of briefs.
  • Massage the perineum area gently with your fingers to relieve pain and swelling. If you’d like, use a natural oil like jojoba or coconut while you massage.
  • Use a sitz bath to relieve any pain, itching, or swelling in the perineum area.
  • Use a perineal irrigation bottle to help clean or wash away any skin damage or sources of irritation.
  • Take pain medication like ibuprofen (Advil) to reduce swelling and pain.
  • Have a doctor drain fluid or pus from a cyst or an abscess.
  • Ask your doctor about surgery to remove a hemorrhoid, cyst, or tumor.

Seek immediate medical help if you notice any of the following symptoms in addition to the perineum lump:

  • discharge with a bad odor coming from your perineum, genitals, or anus
  • bleeding from the perineum, genitals, or anus
  • trouble peeing or pooping
  • swelling and intense pain that makes it hard or impossible to sit
  • fever

Most of the time, a perineum lump is harmless if it doesn’t come with any pain, swelling, or other unusual symptoms.

See your doctor if you notice any abnormal symptoms or if your perineum lump is disrupting your life by making it hard to sit, go to the bathroom, or get by without pain and discomfort.